Provider Enrollment Specialist in Brentwood, TN at Health Support Center

Date Posted: 8/18/2018

Job Snapshot

Job Description

Health Support Center


The Specialist, Provider Enrollment is responsible for requesting participation for providers in and with health plans to minimize the possibility of delay or non-payment of claims for services rendered by practitioners.
  • Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers.
  • Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released.  
  • Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing. 
  • Research payers for information on processes to enroll providers, contact representative information; and status of provider already in the system or not.
  • Update, monitor, and maintain CAQH database with all current provider information that is received from the Market Director.
  • Input and/or maintain data for provider to include but not limited to, initial input of provider demographics, per-sonal, medical documentation, effective dates, and comments. 
  • Maintain updated licenses, add locations and various groups.   
  • Monitor and maintain provider files to determine reason for pending enrollment and/or acknowledge all docu-ments are received; request any documents and user names/passwords needed for enrollments; routinely update status changes.
  • Perform routine administrative tasks to include but not limited to, processing applications, uploading and updated documents, notification forms, enroll provider(s) with all designated payers, and research process with payer in a timely manner. 
  • Communicate and provide updates to designated market contacts. Research payer enrollment questions and issues raised by market representative and /or providers and respond with resolution.

Job Requirements

The requirements listed below are representative of the knowledge, skills and/or abilities required for the job: 
  • High School Diploma or GED equivalency.
  • Minimum of 2 years experience in Insurance Payer Background and/or Enrollment preferred.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran


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